PRV.008.109

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TMSIS Dataguide

Medicaid.gov

Version 3.27.0

SUBMITTING-STATE-PROV-ID

Data Element

DE Number

PRV109

System DE Number

PRV.008.109

File Name

File Segment Number

File Segment Name

PROV-AFFILIATED-GROUPS

Last updated

No Updates

Overview Valid Values Related Rules Related DQ Measures Other Instances

Definition	The State-specific Medicaid Provider Identifier is a state-assigned unique identifier that states should report with all individual providers, practice groups, facilities, and other entities. This should be the identifier that is used in the state's Medicaid Management Information System.
Size	X(30)
FLF Start Position	22
FLF Stop Position	51
Segment Key Field Identifier	2
Coding Requirements	1. Value must be 30 characters or less 2. Mandatory

Valid Value Code Set	Valid Value Code	Valid Value Name	Valid Value Description	Effective Start Date	Effective End Date

RULE ID	RULE Definition
RULE-6834	If a segment is a provider affiliated groups segment from a PRV file, then the submitting state provider identification value reported must be compatible with the specified T-MSIS picture format: X(30).
RULE-2969	All prov affiliated groups segments must have a corresponding prov affiliated main segment where the prov affiliated groups effective and end dates are within the prov affiliated main effective and end dates. Note: Prov affiliated main dates can be consecutive or overlapping.

Measure ID	Measure Name

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
PRV019	PRV.002.019	SUBMITTING-STATE-PROV-ID	PRV00002	PROV-ATTRIBUTES-MAIN
PRV042	PRV.003.042	SUBMITTING-STATE-PROV-ID	PRV00003	PROV-LOCATION-AND-CONTACT-INFO
PRV063	PRV.004.063	SUBMITTING-STATE-PROV-ID	PRV00004	PROV-LICENSING-INFO
PRV075	PRV.005.075	SUBMITTING-STATE-PROV-ID	PRV00005	PROV-IDENTIFIERS
PRV087	PRV.006.087	SUBMITTING-STATE-PROV-ID	PRV00006	PROV-TAXONOMY-CLASSIFICATION
PRV097	PRV.007.097	SUBMITTING-STATE-PROV-ID	PRV00007	PROV-MEDICAID-ENROLLMENT
PRV118	PRV.009.118	SUBMITTING-STATE-PROV-ID	PRV00009	PROV-AFFILIATED-PROGRAMS
PRV128	PRV.010.128	SUBMITTING-STATE-PROV-ID	PRV00010	PROV-BED-TYPE-INFO

Published Date	Data Guide Version	Data Element	Action	Field	Before	After